Optimization of a home hospitalization program for hematopoietic stem cell transplantation with ehealth integration and clinical pharmacist involvement.

Home hospitalization represents an alternative to traditional hospitalization, providing comparable clinical safety for hematological patients. At-home therapies can range from the delivery of intravenous antibiotics to more complex scenarios, such as the care during the early period after hematopoietic stem cell transplantation and chimeric antigen receptor T-cell therapy. Early discharge from conventional hospitalization is feasible and helps reduce hospital resources and waiting lists. The coordinated efforts of multidisciplinary teams, including hematologists, nurses, and pharmacists, ensure patient safety and continuity of care. The traditional model of home hospitalization relies on home visits and telephone consultations with physicians and nurses. However, the use of eHealth technologies, such as MY-Medula, can enhance communication and monitoring, and thereby improve patient outcomes with no additional costs. The active involvement of a clinical pharmacist in home hospitalization programs is essential, not only for the proper logistical management of the medication but also to ensure its appropriateness, optimize treatment, address queries from the team and patients, and promote adherence. In conclusion, the implementation of hematopoietic stem cell transplantation and chimeric antigen receptor T-cell therapy home hospitalization programs that use both an eHealth tool and a multidisciplinary care model can optimize patient care and improve quality of life without increasing healthcare costs.

Feasibility of a New Model of Care for Allogeneic Stem Cell Transplantation Recipients Facilitated by eHealth: The MY-Medula Pilot Study.

The use of allogeneic stem cell transplantation (allo-SCT) for the treatment of hematologic diseases is steadily increasing; however, allo-SCT has the downside of causing considerable treatment-related morbidity and mortality. Mobile technology applied to healthcare (mHealth) has proven to be a cost-effective strategy to improve care and offer new services to people with multimorbidity, but there are little data on its usefulness in allo-SCT recipients. Here we describe a new integrated healthcare model facilitated by an mHealth platform, EMMASalud-MY-Medula, and to report the results of a feasibility and usability pilot study. The MY-Medula platform was developed in 4 phases. First, patient and healthcare professional needs were identified, and technological development and pretesting tests were conducted (phases 1 to 3, January 2016 to March 2021). Then a nonrandomized, prospective, observational, single-center pilot study was conducted (October 2021 to January 2022) at the adult SCT unit of a tertiary university hospital. Twenty-eight volunteer allo-SCT recipients were included in the pilot study, of whom one-half were outpatients in the first-year post-SCT and one-half were affected by steroid-dependent graft-versus-host disease (SR-GVHD). All patients used the MY-Medula app during the 2-month follow-up period, with a median number of visits to the app of 143 (range, 6 to 477). A total of 2067 self-monitoring records were created, and 205 text messages were received, most of them related to symptoms description (47%) and doubts about medication (21%). In 3.4% of the cases, drug dosage was adjusted by the pharmacist because of dosing errors or interactions. At the end of the study, a 6-question Likert-type questionnaire for patients and a 22-question test for healthcare professionals showed a high degree of satisfaction (95% and 100%, respectively) with the new healthcare pathway. Reengineering the follow-up of allo-SCT recipients into an integrated, multidisciplinary model of care facilitated by mHealth tools is feasible and has been associated with high usability and a high degree of satisfaction by patients and healthcare professionals. A randomized trial aiming to determine the cost-effectiveness of MY-Medula-based follow-up post-SCT is currently enrolling participants.

Developing a mHealth intervention to redesign the current journey for people living with HIV: A qualitative study.

OBJECTIVE: People living with human immunodeficiency virus could particularly benefit from mobile health (mHealth). The objective of the study was to  contribute to the design and development of a new standard of care for people  living with human immunodeficiency virus and the mHealth app needed to  support it by 1) exploring the view of people living with human  immunodeficiency virus and healthcare professionals on the possibilities of  mHealth tools on HIV care, and 2) implementing their feedback into the new  app and into the new journey of people living with human immunodeficiency  virus. METHOD: The study was conducted in two different phases: phase one was to  apprise patients' and healthcare professionals' perspectives on mHealth using  the qualitative methodology of the focus groups, whereas phase two aimed to  implement their feedback into the application. RESULTS: A total of five people living with human immunodeficiency virus and  nine healthcare professionals (three clinical pharmacists, three nurses, two  physicians, and one pharmacy technician) participated in the focus groups. The  patients identified the following main aspects to be improved in the  current patients' journey: insufficient information (n = 5), lack of general  population disease awareness (n = 5), and medication dispensation model (n =  3). Moreover, healthcare professionals identified the next health outcomes  to be enhanced with mHealth tools: patients' quality of life (n = 7), control of  the disease (n = 5) and comorbidities (n = 3), and adherence to medication (n = 5). According to these needs, the new healthcare model was designed. The  mHealth was provided with different features, such as information about the  disease, health promotion and prevention, the possibility of two-way patient- healthcare professionals communication, or synchronization with other devices. The new human immunodeficiency virus care journey and the app are currently being tested in a group of people living with human immunodeficiency virus in real-world conditions in our hospital. CONCLUSIONS: Improving patients' quality of life, therapeutic adherence, or  disease control are key objectives for optimizing people living with human  immunodeficiency virus care. Our digital health tool and the new healthcare  model have been implemented based on end-users' feedback to achieve better  patients-healthcare professionals communication and patient engagement with their care.

OBJETIVO: Las personas que viven con el virus de la inmunodeficiencia humana podrían beneficiarse de nuevas estrategias de salud móvil (mSalud). El  objetivo del estudio fue contribuir al diseño y desarrollo de un nuevo modelo  asistencial en la población con virus de la inmunodeficiencia humana y de la  aplicación móvil necesaria para apoyarlo mediante: 1) la exploración de la  visión de personas que viven con el virus de la inmunodeficiencia humana y  profesionales sanitarios sobre las herramientas digitales en la atención a este  colectivo, y 2) la implementación de sus perspectivas en la nueva aplicación y  en la nueva ruta asistencial.Método: El estudio se realizó en dos fases: la primera tenía como objetivo conocer las perspectivas de los participantes sobre la salud móvil mediante la metodología cualitativa de los grupos focales, y la segunda implementar estas valoraciones en la aplicación. RESULTADOS: Participaron cinco pacientes y nueve profesionales sanitarios (tres farmacéuticos clínicos, tres enfermeras, dos médicas y una  técnico de farmacia). Los pacientes consideraron que debían mejorarse los siguientes aspectos en su ruta asistencial: información insuficiente (n = 5),  falta de conocimiento de la enfermedad (n = 5) y modelo de dispensación de la medicación (n = 3). Los profesionales identificaron que debían mejorarse: la  calidad de vida de los pacientes (n = 7), el control de su enfermedad (n = 5) y de sus comorbilidades (n = 3), y la adherencia terapéutica (n = 5). De acuerdo con estas necesidades, se diseñó el nuevo modelo asistencial. Las siguientes  características se incorporaron a la mHealth: información sobre la enfermedad,  promoción y prevención de la salud, posibilidad de comunicación  bidireccional profesional-paciente o sincronización con otros dispositivos. La  nueva ruta asistencial y la aplicación están siendo estudiadas en un grupo de  personas que viven con el virus de la inmunodeficiencia humana en  condiciones de vida real y en seguimiento en nuestro hospital. CONCLUSIONES: La mejora de la calidad de vida, la adherencia terapéutica y el  control de la enfermedad son factores clave para la optimización de la atención de las personas que viven con el virus de la inmunodeficiencia humana.  Nuestra herramienta de salud digital y el modelo asistencial han sido diseñados en base a la opinión de pacientes para mejorar la comunicación profesional- paciente sanitario y conseguir un mayor compromiso de los pacientes con su  cuidado.

Desarrollo de una intervención mHealth para rediseñar la ruta asistencial de las personas que viven con VIH: Estudio cualitativo / Developing a mHealth intervention to redesign the current journey for people living with HIV: A qualitative study

Objetivo: Las personas que viven con el virus de la inmunodeficienciahumana podrían beneficiarse de nuevas estrategias de salud móvil (mSalud). El objetivo del estudio fue contribuir al diseño y desarrollo de unnuevo modelo asistencial en la población con virus de la inmunodeficiencia humana y de la aplicación móvil necesaria para apoyarlo mediante:1) la exploración de la visión de personas que viven con el virus de lainmunodeficiencia humana y profesionales sanitarios sobre las herramientas digitales en la atención a este colectivo, y 2) la implementación desus perspectivas en la nueva aplicación y en la nueva ruta asistencial.Método: El estudio se realizó en dos fases: la primera tenía como objetivo conocer las perspectivas de los participantes sobre la salud móvilmediante la metodología cualitativa de los grupos focales, y la segundaimplementar estas valoraciones en la aplicación.Resultados: Participaron cinco pacientes y nueve profesionales sanitarios (tres farmacéuticos clínicos, tres enfermeras, dos médicas y una técnico de farmacia). Los pacientes consideraron que debían mejorarse lossiguientes aspectos en su ruta asistencial: información insuficiente (n = 5), falta de conocimiento de la enfermedad (n = 5) y modelo de dispensación de la medicación (n = 3). Los profesionales identificaron que debíanmejorarse: la calidad de vida de los pacientes (n = 7), el control de suenfermedad (n = 5) y de sus comorbilidades (n = 3), y la adherencia terapéutica (n = 5). De acuerdo con estas necesidades, se diseñó el nuevomodelo asistencial. (AU)

Objective: People living with human immunodeficiency virus couldparticularly benefit from mobile health (mHealth). The objective of thestudy was to contribute to the design and development of a new standard of care for people living with human immunodeficiency virus andthe mHealth app needed to support it by 1) exploring the view of peopleliving with human immunodeficiency virus and healthcare professionals onthe possibilities of mHealth tools on HIV care, and 2) implementing theirfeedback into the new app and into the new journey of people living withhuman immunodeficiency virus.Method: The study was conducted in two different phases: phase onewas to apprise patients’ and healthcare professionals’ perspectives onmHealth using the qualitative methodology of the focus groups, whereasphase two aimed to implement their feedback into the application.Results: A total of five people living with human immunodeficiency virusand nine healthcare professionals (three clinical pharmacists, three nurses, two physicians, and one pharmacy technician) participated in thefocus groups. The patients identified the following main aspects to be improved in the current patients’ journey: insufficient information (n = 5),lack of general population disease awareness (n = 5), and medicationdispensation model (n = 3). Moreover, healthcare professionals identifiedthe next health outcomes to be enhanced with mHealth tools: patients’quality of life (n = 7), control of the disease (n = 5) and comorbidities(n = 3), and adherence to medication (n = 5). According to these needs,the new healthcare model was designed. (AU)